DAIMLER TRUCK NORTH AMERICA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DAIMLER TRUCK NORTH AMERICA LLC WELFARE BENEFITS PLAN
401k plan membership statisitcs for DAIMLER TRUCK NORTH AMERICA LLC WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2015 : DAIMLER TRUCK NORTH AMERICA LLC WELFARE BENEFITS PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $312,162 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $4,340,682 |
| Total income from all sources (including contributions) | 2015-12-31 | $54,491,303 |
| Total loss/gain on sale of assets | 2015-12-31 | $2,449 |
| Total of all expenses incurred | 2015-12-31 | $61,306,326 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $57,849,692 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $54,485,494 |
| Value of total assets at end of year | 2015-12-31 | $312,162 |
| Value of total assets at beginning of year | 2015-12-31 | $11,155,705 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $3,456,634 |
| Total interest from all sources | 2015-12-31 | $3,360 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $95,901 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $15,286,636 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-12-31 | $-4,271,236 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $245,620 |
| Administrative expenses (other) incurred | 2015-12-31 | $676,428 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $312,162 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $69,446 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-6,815,023 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $6,815,023 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Investment advisory and management fees | 2015-12-31 | $21,766 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $10,888,422 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-12-31 | $3,360 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $9,217,929 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $39,198,858 |
| Employer contributions (assets) at end of year | 2015-12-31 | $312,162 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $21,663 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $52,902,999 |
| Contract administrator fees | 2015-12-31 | $2,662,539 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $4,271,236 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Aggregate proceeds on sale of assets | 2015-12-31 | $2,449 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2015-12-31 | 910189318 |
| 2014 : DAIMLER TRUCK NORTH AMERICA LLC WELFARE BENEFITS PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $4,340,682 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $3,862,481 |
| Total income from all sources (including contributions) | 2014-12-31 | $49,213,920 |
| Total loss/gain on sale of assets | 2014-12-31 | $1,614 |
| Total of all expenses incurred | 2014-12-31 | $58,622,898 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $55,600,400 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $49,210,814 |
| Value of total assets at end of year | 2014-12-31 | $11,155,705 |
| Value of total assets at beginning of year | 2014-12-31 | $20,086,482 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $3,022,498 |
| Total interest from all sources | 2014-12-31 | $1,492 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $89,310 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $15,807,859 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-12-31 | $496,672 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $245,620 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $246,095 |
| Administrative expenses (other) incurred | 2014-12-31 | $238,705 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $69,446 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $87,917 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-9,408,978 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $6,815,023 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $16,224,001 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Investment advisory and management fees | 2014-12-31 | $21,895 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $10,888,422 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $19,812,631 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $1,492 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $9,232,610 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $33,402,955 |
| Employer contributions (assets) at end of year | 2014-12-31 | $21,663 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $27,756 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $45,871,118 |
| Contract administrator fees | 2014-12-31 | $2,672,588 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $4,271,236 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $3,774,564 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Aggregate proceeds on sale of assets | 2014-12-31 | $1,614 |
| Aggregate carrying amount (costs) on sale of assets | 2014-12-31 | $0 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2014-12-31 | 910189318 |
| 2013 : DAIMLER TRUCK NORTH AMERICA LLC WELFARE BENEFITS PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $3,862,481 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $4,408,822 |
| Total income from all sources (including contributions) | 2013-12-31 | $62,957,110 |
| Total of all expenses incurred | 2013-12-31 | $59,721,450 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $56,478,182 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $62,951,382 |
| Value of total assets at end of year | 2013-12-31 | $20,086,482 |
| Value of total assets at beginning of year | 2013-12-31 | $17,397,163 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $3,243,268 |
| Total interest from all sources | 2013-12-31 | $4,729 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $86,969 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $15,504,410 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-12-31 | $393,066 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-12-31 | $-602,175 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $246,095 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $667,041 |
| Administrative expenses (other) incurred | 2013-12-31 | $346,937 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $87,917 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $32,083 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $3,235,660 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $16,224,001 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $12,988,341 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Investment advisory and management fees | 2013-12-31 | $22,130 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-12-31 | $19,812,631 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-12-31 | $16,730,122 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $4,729 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $9,623,546 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-12-31 | $999 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $47,053,906 |
| Employer contributions (assets) at end of year | 2013-12-31 | $27,756 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $47,456,811 |
| Contract administrator fees | 2013-12-31 | $2,787,232 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $3,774,564 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $4,376,739 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2013-12-31 | 910189318 |
| 2012 : DAIMLER TRUCK NORTH AMERICA LLC WELFARE BENEFITS PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $4,408,822 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $2,967,619 |
| Total income from all sources (including contributions) | 2012-12-31 | $49,094,443 |
| Total of all expenses incurred | 2012-12-31 | $57,506,608 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $54,424,509 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $49,080,087 |
| Value of total assets at end of year | 2012-12-31 | $17,397,163 |
| Value of total assets at beginning of year | 2012-12-31 | $24,368,125 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $3,082,099 |
| Total interest from all sources | 2012-12-31 | $14,356 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $86,293 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $14,286,328 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-12-31 | $389,623 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-12-31 | $1,443,383 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $667,041 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $307,103 |
| Administrative expenses (other) incurred | 2012-12-31 | $511,630 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $32,083 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $34,263 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-8,412,165 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $12,988,341 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $21,400,506 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Investment advisory and management fees | 2012-12-31 | $21,483 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-12-31 | $16,730,122 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-12-31 | $0 |
| Interest earned on other investments | 2012-12-31 | $8,544 |
| Value of interest in common/collective trusts at end of year | 2012-12-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2012-12-31 | $20,711,211 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $3,349,811 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $3,349,811 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $5,812 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $8,580,703 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $34,404,136 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $44,400,423 |
| Contract administrator fees | 2012-12-31 | $2,462,693 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $4,376,739 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $2,933,356 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2012-12-31 | 910189318 |
| 2011 : DAIMLER TRUCK NORTH AMERICA LLC WELFARE BENEFITS PLAN 2011 401k financial data |
|---|
| Total transfer of assets to this plan | 2011-12-31 | $34,074,919 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $2,967,619 |
| Total income from all sources (including contributions) | 2011-12-31 | $41,080,013 |
| Total of all expenses incurred | 2011-12-31 | $53,754,426 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $51,113,139 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $40,762,033 |
| Value of total assets at end of year | 2011-12-31 | $24,368,125 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $2,641,287 |
| Total interest from all sources | 2011-12-31 | $14,827 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $137,099 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $10,114,294 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-12-31 | $4,518,372 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-12-31 | $2,941,110 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $307,103 |
| Other income not declared elsewhere | 2011-12-31 | $303,153 |
| Administrative expenses (other) incurred | 2011-12-31 | $4,939 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $34,263 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-12,674,413 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $21,400,506 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Investment advisory and management fees | 2011-12-31 | $20,858 |
| Interest earned on other investments | 2011-12-31 | $6,034 |
| Value of interest in common/collective trusts at end of year | 2011-12-31 | $20,711,211 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $3,349,811 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $8,793 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $5,447,509 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $26,129,367 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $42,724,520 |
| Contract administrator fees | 2011-12-31 | $2,478,391 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $2,933,356 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | MOSS ADAMS LLP |
| Accountancy firm EIN | 2011-12-31 | 910189318 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 160938 |
| Policy instance | 3 |
| Insurance contract or identification number | 160938 | | Number of Individuals Covered | 15363 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 16356 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $95 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,113,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 95 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 744 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,665,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 160938 |
| Policy instance | 3 |
| Insurance contract or identification number | 160938 | | Number of Individuals Covered | 14641 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 16470 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $55 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $5,001,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 55 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 822 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $6 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,203,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 859 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $6 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,697,324 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 10022 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $53 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $3,193,238 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 53 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 160938 |
| Policy instance | 3 |
| Insurance contract or identification number | 160938 | | Number of Individuals Covered | 14641 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10008258 |
| Policy instance | 4 |
| Insurance contract or identification number | 10008258 | | Number of Individuals Covered | 25277 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 160938 |
| Policy instance | 3 |
| Insurance contract or identification number | 160938 | | Number of Individuals Covered | 14641 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 10296 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $77 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $3,776,537 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 77 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 987 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $588 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,780,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 588 | | Additional information about fees paid to insurance broker | 1ST QUARTER DOUBLE RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10008258 |
| Policy instance | 5 |
| Insurance contract or identification number | 10008258 | | Number of Individuals Covered | 24940 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10008258 |
| Policy instance | 4 |
| Insurance contract or identification number | 10008258 | | Number of Individuals Covered | 24940 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 160938 |
| Policy instance | 3 |
| Insurance contract or identification number | 160938 | | Number of Individuals Covered | 12956 | | Insurance policy start date | 2016-05-01 | | Insurance policy end date | 2017-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $11,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 25272 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $79 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $6,846,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 79 | | Additional information about fees paid to insurance broker | NON MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK INS SERVICES WEST INC |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 1042 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,660,181 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 1029 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,184,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 4714 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,813 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $3,027,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,813 | | Insurance broker organization code? | 3 | | Insurance broker name | AON CONSULTING |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 8439 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,768 | | Total amount of fees paid to insurance company | USD $13 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,630,322 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,768 | | Amount paid for insurance broker fees | 13 | | Additional information about fees paid to insurance broker | NONMONETARY | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK INS SERVICES WEST INC |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 1180 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,610,994 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 33251 ) |
| Policy contract number | 10008258 |
| Policy instance | 3 |
| Insurance contract or identification number | 10008258 | | Number of Individuals Covered | 9827 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 1403 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,716,998 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 9168 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $7 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,275,052 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION. | | Insurance broker organization code? | 3 | | Insurance broker name | AON RISK INS SERVICES WEST INC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 6785 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $2,272,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 1354 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,312,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 00305A |
| Policy instance | 3 |
| Insurance contract or identification number | 00305A | | Number of Individuals Covered | 31 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $472,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0117550 |
| Policy instance | 2 |
| Insurance contract or identification number | 0117550 | | Number of Individuals Covered | 9015 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $1,008,807 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1331 |
| Policy instance | 1 |
| Insurance contract or identification number | 1331 | | Number of Individuals Covered | 1243 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,137,767 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
